|
MESH ULTRAPRO HERN SYS LRG
|
Facility
|
OP
|
$4,162.15
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$100.31 |
| Max. Negotiated Rate |
$2,081.07 |
| Rate for Payer: Aetna Commercial |
$1,581.62
|
| Rate for Payer: Aetna Medicare Advantage |
$1,248.64
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,061.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,061.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$832.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,061.35
|
| Rate for Payer: Cigna Commercial |
$2,081.07
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,007.24
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$915.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$624.32
|
| Rate for Payer: UnitedHealthcare Community & State |
$100.31
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$110.30
|
|
|
MESH ULTRAPRO HERN SYS LRG
|
Facility
|
IP
|
$4,162.15
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.32 |
| Max. Negotiated Rate |
$1,007.24 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$832.43
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,007.24
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$915.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$624.32
|
|
|
MESH ULTRAPRO HERN SYS MED
|
Facility
|
OP
|
$4,082.90
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$2,041.45 |
| Rate for Payer: Aetna Commercial |
$1,551.50
|
| Rate for Payer: Aetna Medicare Advantage |
$1,224.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,041.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,041.14
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$816.58
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,041.14
|
| Rate for Payer: Cigna Commercial |
$2,041.45
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$988.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$898.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$612.43
|
| Rate for Payer: UnitedHealthcare Community & State |
$98.40
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$108.20
|
|
|
MESH ULTRAPRO HERN SYS MED
|
Facility
|
IP
|
$4,082.90
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.43 |
| Max. Negotiated Rate |
$988.06 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$816.58
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$988.06
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$898.24
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$612.43
|
|
|
MESH VENTIO ST HERNIA SMALL
|
Facility
|
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270688689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.35 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna Commercial |
$1,330.00
|
| Rate for Payer: Aetna Medicare Advantage |
$1,050.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$892.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$700.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$892.50
|
| Rate for Payer: Cigna Commercial |
$1,750.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$847.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$770.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$525.00
|
| Rate for Payer: UnitedHealthcare Community & State |
$84.35
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$92.75
|
|
|
MESH VENTIO ST HERNIA SMALL
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270688689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$847.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$700.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$847.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$770.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$525.00
|
|
|
MESH VENTRAL 4 X 6 ELLIPCE
|
Facility
|
IP
|
$3,897.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.55 |
| Max. Negotiated Rate |
$943.07 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$779.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$943.07
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$857.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$584.55
|
|
|
MESH VENTRAL 4 X 6 ELLIPCE
|
Facility
|
OP
|
$3,897.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$93.92 |
| Max. Negotiated Rate |
$1,948.50 |
| Rate for Payer: Aetna Commercial |
$1,480.86
|
| Rate for Payer: Aetna Medicare Advantage |
$1,169.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$993.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$993.74
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$779.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$993.74
|
| Rate for Payer: Cigna Commercial |
$1,948.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$943.07
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$857.34
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$584.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$93.92
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$103.27
|
|
|
MESH VENTRALEX ST PATCH LARGE
|
Facility
|
IP
|
$7,832.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.80 |
| Max. Negotiated Rate |
$1,895.34 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,566.40
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,895.34
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,723.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,174.80
|
|
|
MESH VENTRALEX ST PATCH LARGE
|
Facility
|
OP
|
$7,832.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698961
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.75 |
| Max. Negotiated Rate |
$3,916.00 |
| Rate for Payer: Aetna Commercial |
$2,976.16
|
| Rate for Payer: Aetna Medicare Advantage |
$2,349.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,997.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,997.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,566.40
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,997.16
|
| Rate for Payer: Cigna Commercial |
$3,916.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,895.34
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,723.04
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,174.80
|
| Rate for Payer: UnitedHealthcare Community & State |
$188.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$207.55
|
|
|
MESH VENTRALEX ST PATCH MEDIUM
|
Facility
|
IP
|
$7,034.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.17 |
| Max. Negotiated Rate |
$1,702.35 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,406.90
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,702.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,547.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,055.17
|
|
|
MESH VENTRALEX ST PATCH MEDIUM
|
Facility
|
OP
|
$7,034.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$169.53 |
| Max. Negotiated Rate |
$3,517.25 |
| Rate for Payer: Aetna Commercial |
$2,673.11
|
| Rate for Payer: Aetna Medicare Advantage |
$2,110.35
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,793.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,793.80
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,406.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,793.80
|
| Rate for Payer: Cigna Commercial |
$3,517.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,702.35
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,547.59
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,055.17
|
| Rate for Payer: UnitedHealthcare Community & State |
$169.53
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$186.41
|
|
|
MESH VENTRALEX ST PATCH SMALL
|
Facility
|
OP
|
$5,868.65
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.43 |
| Max. Negotiated Rate |
$2,934.32 |
| Rate for Payer: Aetna Commercial |
$2,230.09
|
| Rate for Payer: Aetna Medicare Advantage |
$1,760.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1,496.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1,496.51
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,173.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1,496.51
|
| Rate for Payer: Cigna Commercial |
$2,934.32
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,420.21
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,291.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$880.30
|
| Rate for Payer: UnitedHealthcare Community & State |
$141.43
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$155.52
|
|
|
MESH VENTRALEX ST PATCH SMALL
|
Facility
|
IP
|
$5,868.65
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.30 |
| Max. Negotiated Rate |
$1,420.21 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,173.73
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1,420.21
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,291.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$880.30
|
|
|
MESH VENTRALIGHT 10 X 13 ELLIP
|
Facility
|
IP
|
$14,140.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,121.07 |
| Max. Negotiated Rate |
$3,422.00 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,828.10
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,422.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,110.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,121.07
|
|
|
MESH VENTRALIGHT 10 X 13 ELLIP
|
Facility
|
OP
|
$14,140.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$340.79 |
| Max. Negotiated Rate |
$7,070.25 |
| Rate for Payer: Aetna Commercial |
$5,373.39
|
| Rate for Payer: Aetna Medicare Advantage |
$4,242.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,605.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,605.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,828.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,605.83
|
| Rate for Payer: Cigna Commercial |
$7,070.25
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,422.00
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,110.91
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,121.07
|
| Rate for Payer: UnitedHealthcare Community & State |
$340.79
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$374.72
|
|
|
MESH VENTRALIGHT 6 X 10 OVAL
|
Facility
|
OP
|
$8,371.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.75 |
| Max. Negotiated Rate |
$4,185.75 |
| Rate for Payer: Aetna Commercial |
$3,181.17
|
| Rate for Payer: Aetna Medicare Advantage |
$2,511.45
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,134.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,134.73
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,674.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,134.73
|
| Rate for Payer: Cigna Commercial |
$4,185.75
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,025.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,841.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,255.72
|
| Rate for Payer: UnitedHealthcare Community & State |
$201.75
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$221.84
|
|
|
MESH VENTRALIGHT 6 X 10 OVAL
|
Facility
|
IP
|
$8,371.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,255.72 |
| Max. Negotiated Rate |
$2,025.90 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,674.30
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,025.90
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$1,841.73
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,255.72
|
|
|
MESH VENTRALIGHT RECG 12 X 14
|
Facility
|
IP
|
$14,905.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,235.75 |
| Max. Negotiated Rate |
$3,607.01 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,981.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,607.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,279.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,235.75
|
|
|
MESH VENTRALIGHT RECG 12 X 14
|
Facility
|
OP
|
$14,905.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270690903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.21 |
| Max. Negotiated Rate |
$7,452.50 |
| Rate for Payer: Aetna Commercial |
$5,663.90
|
| Rate for Payer: Aetna Medicare Advantage |
$4,471.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,800.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,800.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,981.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,800.78
|
| Rate for Payer: Cigna Commercial |
$7,452.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,607.01
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$3,279.10
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2,235.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$359.21
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$394.98
|
|
|
MESH VENTRAL PHASIX 10X12IN
|
Facility
|
OP
|
$72,185.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,739.66 |
| Max. Negotiated Rate |
$36,092.50 |
| Rate for Payer: Aetna Commercial |
$27,430.30
|
| Rate for Payer: Aetna Medicare Advantage |
$21,655.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18,407.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18,407.17
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14,437.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18,407.17
|
| Rate for Payer: Cigna Commercial |
$36,092.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17,468.77
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$15,880.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10,827.75
|
| Rate for Payer: UnitedHealthcare Community & State |
$1,739.66
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1,912.90
|
|
|
MESH VENTRAL PHASIX 10X12IN
|
Facility
|
IP
|
$72,185.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270698769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,827.75 |
| Max. Negotiated Rate |
$17,468.77 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$14,437.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17,468.77
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$15,880.70
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10,827.75
|
|
|
MESH VENTRIO 10.8x13.7 XL OVAL
|
Facility
|
OP
|
$13,307.60
|
|
| Hospital Charge Code |
270647199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$320.71 |
| Max. Negotiated Rate |
$6,653.80 |
| Rate for Payer: Aetna Commercial |
$5,056.89
|
| Rate for Payer: Aetna Medicare Advantage |
$3,992.28
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3,393.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3,393.44
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,661.52
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3,393.44
|
| Rate for Payer: Cigna Commercial |
$6,653.80
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,220.44
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,927.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,996.14
|
| Rate for Payer: UnitedHealthcare Community & State |
$320.71
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$352.65
|
|
|
MESH VENTRIO 10.8x13.7 XL OVAL
|
Facility
|
IP
|
$13,307.60
|
|
| Hospital Charge Code |
270647199
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,996.14 |
| Max. Negotiated Rate |
$3,220.44 |
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$2,661.52
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$3,220.44
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,927.67
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,996.14
|
|
|
MESH VENTRIO 8.7 x 10
|
Facility
|
OP
|
$9,775.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
270663620
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.58 |
| Max. Negotiated Rate |
$4,887.50 |
| Rate for Payer: Aetna Commercial |
$3,714.50
|
| Rate for Payer: Aetna Medicare Advantage |
$2,932.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$2,492.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$2,492.62
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health |
$1,955.00
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$2,492.62
|
| Rate for Payer: Cigna Commercial |
$4,887.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$2,365.55
|
| Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan |
$2,150.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1,466.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$235.58
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$259.04
|
|